The Food Medic - S5 E2 Periods, Performance and Recovery

Episode Date: January 11, 2021

On this episode, Dr Hazel is joined by Kelly Mc Nulty, a PhD student at Northumbria University investigating the effects of the menstrual cycle and hormonal contraceptive use on performance, recovery, and adaptation in sportswomen. They chat all about how periods affect strength and performance in sport and exercise. Topics covered include:* Training around the menstrual cycle* Differences in strength and performance across the menstrual cycle* Injury susceptibility, recovery and sleep at different phases of the menstrual cycle* Period tracking methods* Oral contraceptive use and the impact on strength and performance* The menstrual cycle changes during the pandemic. Don’t forget to rate, review and subscribe if you enjoyed this podcast! Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello and a very big welcome back to the Food Medic podcast. I'm your host, Dr. Hazel Wallace. I'm a medical doctor, registered associate nutritionist and a bestselling author. For more about me and the work that I do, head over to www.thefoodmedic.co.uk and make sure to check us out on all social media platforms under The Food Medic. This podcast episode is sponsored by murad murad is the dermatologist developed skincare brand that approaches skin differently how through founder dr howard murad's four main pillars of wellness for total skin health eat your water awaken your body be kind to your mind and of course nourish your skin with their high performance formulas

for more than 30 years Murad has been committed to developing clinically proven cruelty-free products that meet the meticulous standards for safety, efficacy and care you'd expect from a doctor. My personal favorite product is their best-selling Retinol Youth Renewal Eye Serum. Retinol is a derivative of vitamin A which helps improve skin cell turnover and reduce the breakdown of collagen. I find this product is great for reducing the appearance of fine lines and improving skin texture. It's suitable for all skin types even sensitive skin and you can use it all over your eye area including the lids. Thank you to Murad for supporting the Food Medic podcast.

On this episode, I'm delighted to be joined by Kelly McNulty. Kelly is a PhD student at Northumbria University investigating the effects of the menstrual cycle and hormonal contraceptive use on performance, recovery and adaptation in sportswomen. She recently launched a project and podcast coming soon, The Period of the Period, which aims to promote awareness and increase evidence-based education on the topics surrounding women's health in sport and exercise. For any of our male listeners who may not think this is for them, I urge you to keep listening and please share this podcast with the women in your life. This is an important conversation for urge you to keep listening and please share this podcast with the women in your life. This is an important conversation for all of us to have and hopefully the start of many more around the menstrual cycle. So first things first, how I came across you initially was because of your research paper, which was published this year.

And I would love to start off just asking you a bit about you, your background, your research and what you're doing now. Yeah so I'm a PhD student at Northumbria University and my main interests are focused around the female athlete and investigating the effects of the menstrual cycle and hormonal contraceptive use on performance recovery adaptation. So I've always had a keen interest in human physiology and how we can optimize human performance, particularly in sport and exercise. So I completed an undergraduate degree in sport and exercise science, followed by a master's in strength and conditioning, and they were both at Northumbria Uni so like most people I got into this space because it was something that had an impact on my health and my performance particularly when

I was growing up playing sport I had a lot of questions regarding the effects of the menstrual cycle and then hormonal contraceptive use on my performance and training but there weren't really many answers available out there or it wasn't something that was openly discussed so although we've got research dating as far back as 1876 into women's specific performance surprisingly we still know very little especially around the effects of the menstrual cycle and this lack of research limits our ability to adopt an evidence approach when working with female athletes and what that means at the moment in sport is women athletes usually train in a similar way to men which if we think about it logically might mean we're failing to maximize their

performance potential as we're taking this male performance model and just sticking it on to women but recently there seems to be an increased interest in this area and an increased drive for research and that's great to see so I guess I just wanted to be part of that movement to bridge the gap in research but then also share that information that I've learned to help optimize performance in all women. Yeah absolutely no it's's, you're so right. There's definitely a huge movement towards trying to gain an understanding as to how the menstrual cycle impacts performance and not just performance, but lots of aspects of, of our lifestyle and not just relating to athletes, but also all women. And it's really interesting, but like you said, we, we definitely need more

research. So let's dive right into training around the menstrual cycle. I think that's a really great place to start. And maybe just briefly covering off, what are the main phases of the menstrual cycle so that we're all on the same page before we start chatting about how it impacts how we exercise? Yeah, so the menstrual cycle. So women have two predominant sex hormones. There are many other hormones involved in our menstrual cycle, but the two main hormones are oestrogen and progesterone. And across a textbook 28 day cycle. But it's also worth noting here that we aren't all textbooks and that only 30% of women have this 28 day cycle. So don't worry if you or if you're working with a female athlete and they don't have that strict 28 day cycle because a normal cycle is considered somewhere between 21 and 35 days.

But across 28 days, the sex hormones ebb and flow. For example at the start of the cycle, so day one which is the first day of your period, oestrogen, progesterone are low and then after that one of the hormones oestrogen starts to increase and reaches its peak just prior to ovulation, so around day 11 or 12 in this textbook example. Then after ovulation oestrogen begins to drop off before it has a secondary peak around days 20 to 23 and around this time progesterone which also started increasing after ovulation also reaches its peak following this if fertilization hasn't occurred both hormones drop off and then begin that cycle again i I'm sitting here totally waving my hands around. So basically, what it means is you have these three main phases. So at the start of your cycle,

estrogen and progesterone are low, then estrogen reaches its peak and progesterone remains low in the middle of the cycle. And then finally, estrogen has a secondary peak and progesterone peaks in that final third of the cycle. Yeah and those you know we we have different names for the cycles that tend to come up in research which is probably important to cover off as well the follicular or the proliferative phase which is the first part of the cycle and the luteal phase which is the second and of course then we have ovulation in the middle. Yeah so we in the research tend to call it so that early phase when they're both low as the early follicular phase then we have the middle phase so that ovulatory phase when oestrogen is high and progesterone is low and then we normally say the mid luteal phase is when we have both hormones high. Amazing. So based on the research, do we see clear differences

in strength and performance in these different phases of the cycle? Yeah, so that's a great question. So whilst the primary function of the menstrual cycle is reproduction, the fluctuations in these hormones across the menstrual cycle also influence so many other physiological systems which can then affect performance. In terms of strength performance we have both oestrogen and progesterone receptors in our muscles and oestrogen is known for its anabolic effects whereby it can influence muscle size and strength but also its effects on the nervous system which play an important role in strength performance. So theoretically, when oestrogen is high around the middle of your cycle and in the final third of the cycle, it's possible that

this might have a positive effect on strength performance. Additionally, progesterone is thought to oppose these oestrogen effects estrogen effects therefore we could speculate that the beneficial effects of estrogen are likely going to be greater around that ovulatory middle of your cycle when estrogen is high without the interference of progesterone compared to the final third of the cycle so the mid luteal phase when both hormones are high however research on the menstrual cycle and strength is inconsistent so some studies have reported improved performance in that early follicular phase, as well as the ovulatory phase and the midluteal phase, whereas many other studies have shown no effect at all. menstrual cycle phase. But like you say, this provided the rationale for my first PhD study, whereby we investigated whether the changes in hormone levels between menstrual cycle phases affect exercise performance. So this was strength performance, as well as endurance performance.

And we did this by finding and analyzing all of the previous studies on this topic. And we also examined the quality of these studies so what we found was that exercise performance might be slightly reduced in some women when oestrogen and progesterone are low so this early follicular phase which is roughly days one to five of the menstrual cycle but it's important to understand that a large proportion of these studies were classified as low in quality and the effect of the menstrual cycle was so variable between studies. So when you add all of that up together, so the small effect size, the poor quality of the research and the variability, general guidelines on exercise performance could not and should not be formed so instead we recommend that females and those working with female athletes take that personalized approach whereby they track and consider their menstrual cycle and are aware of these potential times during the cycle where performance might

be better or worse but they shouldn't just assume that that average results apply to them. Yeah, absolutely. Okay, so based on what you found, and I know that you summarized to say that there may be reduced performance at the start of the cycle. But again, based on all of the evidence, it's not very strong. And therefore, we should just kind of allow women to track it individually and see what comes up and would that be your I guess advice to women who are listening and wanting to integrate menstrual cycle tracking into their training programs to just not kind of focus too much on I could potentially see a dip in my performance here and more so just kind of see where are you picking up patterns? Yeah, definitely. So our reviews were looking at performance. So does your performance on any given day change across the menstrual cycle?

And we weren't really looking at that phase based training. So can we program certain training sessions to sort of maximize our adaptation, if that makes sense? So yeah, definitely what you said about the tracking, it's definitely more of an individual approach. So we don't really know if we can sort of train around our cycle yet. So like I touched on before, sport and performance support in sport or exercise has largely been designed for men. So the support that we apply to female athletes whether that be performance or training is largely based on what has been researched in men or successful in male athletes but with more women participating in sport and exercise and that's at all levels it's become increasingly

important to understand the physiology of the female athlete and how this might affect upon their performance and training however aspects of female physiology make studying women not impossible but slightly more trickier or expensive or time consuming when studying men so what that means is we've got that sort of rise in women's sport but the research is still lacking behind so like i said before we're largely taking this male model of performance and training and then applying it to women and lots of that will apply because the majority of sport and science research will benefit both men and women but because there are such fundamental differences between the sexes this approach might not always be optimal in fact if we look at phase-based training for say strength there's a recent paper

by thompson at all that reviewed all of these previous studies on the topic of which there are only four that have looked at strength training across the menstrual cycle and generally the results from these studies do indicate that follicular phase-based training so training more in your follicular phase than any other phase is better than regular or luteal phase-based resistance training for developing strength and muscle mass but then it's so difficult to be able to draw conclusions from these because not only is there a small amount of research but because of the quality of these studies so while scheduling training based on the menstrual cycle is such an interesting concept and I love it and to some degree very popular in the media

right now you can see why we need that higher quality research before we start making recommendations on training but I don't think we should be disheartened by the lack of that research and I still think we should feel like we can work with female physiology with what knowledge and understanding we do have at the minute so whilst we wait for the research there are things that we can do in the meantime. Yeah absolutely but moving slightly away from training and performance how else might the menstrual cycle affect female athletes because obviously these hormones aren't just orchestrating the menstrual cycle affect female athletes? Because obviously these hormones aren't just orchestrating the menstrual cycle in our periods, but they also are involved in other kind of organs and organ systems in the body. Yeah, so quite a popular one is injury. So in

particular, the ACL injury. So research shows that women and girls are particularly at higher risk for this type of injury with rates of three to six times greater than men. And research has indicated that the fluctuations in women's sex hormones across the menstrual cycle might influence injury risk. Specifically, there's a recent review where the authors concluded that knee ligament laxity and acl injury might be increased during the ovulatory phase of the menstrual cycle so that's obviously something to take into consideration but again high quality research is needed in fact actually i think i'm aware that there's a phd student at nottingham trent university who's looking into this so watch that space and then you've also got sleep so sleep's been massive in recent years and there's some interesting research around

the influence of the menstrual cycle on sleep for instance it's been reported that 30% of women report disturbed sleep during their period and 23% of women report disturbed sleep in the week leading up to that period. In contrast, you might experience better sleep in that luteal phase of the cycle as progesterone increases as this hormone is known as the common hormone and promotes melatonin production. But having said that progesterone also has a thermogenic effect. So you might notice disturbed sleep because of that increased body temperature but again the research is very minimal but just by being aware of this and tracking potential sleep changes you can adopt good sleep hygiene practices to negate these effects on your sleep and then we also have recovery so recovery is an essential component of training. And oestrogen has been

shown to have a protective function in exercise induced muscle damage. So it might be that on certain days of the cycle, we might recover more quickly from a training session, namely when oestrogen is high, such as that late follicular and ovulatory phase of the menstrual cycle. However, again, there is very little research looking into how recovery might vary across the menstrual cycle but the data that is available so far does support that the menstrual cycle might affect the aspects of recovery from training and it's an avenue worth exploring further and in fact that's actually what my next PhD study is investigating. Yeah it's interesting and I guess similar to the

fluctuations we see in the menstrual cycle we also see some of these changes in other parts of the lifespan like pregnancy and menopause where we have other changes in those hormones like I know sleep is massively compromised particularly in pregnancy and also in the menopause and again that's all due to these hormones it's it's interesting because a lot of people are aware that oestrogen is a female sex hormone even though both males and females have it but we don't really consider the widespread effects of it and there's basically oestrogen receptors all over the body yeah and kelly i know this is not your field of research but are there any changes to nutrition that need to be considered at the different phases of the menstrual cycle particularly looking at athletes and performance yeah so totally gonna

hold my hands up and say nutrition really isn't my expertise or my background but i'm sure it's something that people are considering and i guess one thing to note especially for female athletes and exercising women is that we need to think of food as a way of sort of nourishing our bodies so that they can be equipped to carry out not only the essential functions like the menstrual cycle but also optimize our performance training and recovery athletes that don't get the right fuel they need to train and perform can develop relative energy deficiency in sport or reds which has various consequences on not only performance but health so including the loss of the menstrual cycle which isn't a normal part of training performance like

it's sometimes made out to be i won't go into too much detail on that because I know I've listened to topics on previous podcasts by you but I do think very few people realize the connection between food and women's health but I'm sure in that nutrition space that those are kind of being considered yeah yeah it's quite complicated and I think from a nutrient utilization point of view so whether we're more uh kind of glucose or fat dominant that seems to be where the research is at and more for performance point of view so endurance athletes like are they using more fats for fuels or more carbohydrates for fuels but from a general population level of of advice I think we're not there yet to be able to make any kind of

recommendations but again it's like listening to your own body if you're tracking your cycle you can try different nutrition strategies around your training see what makes you feel good and I think that's kind of where we're at at the moment yeah and then just we've kind of briefly mentioned a couple of methods for period tracking and and apps and things are there any particular methods that you advise using or is a kind of a combination of several methods yeah so I'm a massive fan of cycle tracking and I know that it's a straightforward concept but the menstrual cycle can be easily tracked by using pen and paper and to do that I would suggest annotating the start and end of your period and when ovulation occurs and then noting any physical emotional performance changes on each day of the cycle. In a training context I

would also recommend using ovulation kits or if these aren't available you can look out for other physical signs of ovulation such as a rise in basal body temperature taken every morning upon waking or white vaginal fluid that's stretchy and slippery and looks like egg whites one menstrual cycle diary I saw recently with an athlete was using an Excel spreadsheet, whereby she'd had the number of days listed, and when her period and ovulation occurred in one column, and then had columns for performance, training, recovery, and then had color coded each day as green, amber, and red. And I thought it was a really clever idea because I'd not seen anything like it, but it was really handy for looking back and spotting patterns

really easily. There are also many apps like you say which can be used to track the menstrual cycle such as Clue but one that stands out in particular is Fit Our Woman which is an app for female athletes to help sync your training, nutrition and recovery around your menstrual cycle. One thing I think I would know about using apps to track your cycle is that the information they give is often very generic and given the variety and menstrual cycle experiences between and within women month to month the information presented might not always be suited to you and also if you've got your app sort of barking at you that you might should be feeling like this when you don't have them symptoms at all it can be a bit sort of anxiety inducing even so

no matter what your method is of tracking I would encourage you to track for at least three months to allow meaningful conclusions about your cycle patterns to be made yeah absolutely it can also be really tricky if you have any um irregularities in your cycle so if you suffer from PCOS or any conditions that are related to the cycle you can't really draw conclusions I know myself I've got PCOS and uh it's very difficult using the apps because they try to predict when it's going to happen and yeah I've kind of I'm still tracking using apps but I'm also I find it that I'm so clued into my own body that that's almost my best app if that makes sense but they are really useful and it's so great to see so many different types available now yeah another question which um quite a few people have asked me is how the oral contraceptive pill affects performance because obviously that's synthetic hormones that we are putting into our

bodies. Yeah so the oral contraceptives are designed to prevent pregnancy but they are also used by many women to manipulate their menstrual cycle so they can control the timing of or limit entirely their periods. For instance some sports women or just exercising women find having periods inconvenient being an extra concern for training competition and some experience negative side effects from their periods which could adversely affect their performance. So the most popular kind of oral contraceptive in female athletes has a 28-day cycle whereby one pill is taken every day for 21 continuous days followed by seven pill-free days whereby the withdrawal bleed occurs and this alters the physiology of a female in two main ways. So one, by suppressing the natural hormones which we produce throughout the pill cycle.

And then two, by providing us with an artificial oestrogen and progesterone during the 21 pill-taking days. And I guess what that means is that instead of having your natural hormones ebb and flow, as I described before, your natural levels of oestrogen and progesterone are just down regulated almost like a flat line and in addition to this every time an athlete consumes her pill on those 21 pill taking days she's putting some artificial oestrogen and progesterone into her body which peaks within one hour of taking the pill and then drops off but because you get that repeated effect you get get that build up over time. And so despite the prevalence of oral contraceptive use, the effects of oral contraceptives on performance and training are still poorly understood. And just like the menstrual

cycle, the research is very conflicting. And that was actually, again, the rationale for that second study of my PhD. So does oral contraceptive use influence exercise performance? And what we kind of saw was a very similar story in that the results indicated that on average, oral contraceptive use might result in that slightly poorer exercise performance when compared to naturally menstruating women. However, again, the differences between studies meant that we couldn't make those general guidelines, which which again is why we recommended that individualized approach to oral contraceptive use whereby the focus is on each athlete's response to their oral contraceptive so some athletes might be affected and others might not be affected at all and yeah our review showed

that exercise performance did not change between those pill taking and pill free days so female athletes might not need to worry about what day of the oral contraceptive cycle are on when considering performance so again it's just frustrating or exciting that we haven't got that blueprint which says 100% do that it's more about problem solving and figuring out what works best for you and your own data as well as using the research to date yeah and in your review were you looking specifically at the combined oral contraceptive yeah that's the one yeah there's so many different hormonal profiles there's so many different ones but obviously that would be oestrogen and progesterone whereas some of them

are going to be progesterone only and there's there's so many different forms of contraception I'm always quite aware when I talk about contraception on here any any kind of platform to kind of flag to women that there's never any judgment and there's so many so many different methods and people are so personal when it comes to these things so like Kelly said we don't have hard and fast conclusive evidence here and there's definitely nothing standing out to say that it's massively impairing performance so yeah I think we need to be sensitive to the fact that for some people that's the right contraception for them yeah yeah there has been a lot of that oral contraceptive or any contraceptive sort of shaming at the minute and ultimately they've allowed women to achieve what wouldn't have been able to achieve if they

weren't here so not only in life but in sport so yeah I don't think there's any sort of shame around them at all but definitely I get what you mean about women sort of not wanting to admit that they're on a contraceptive pill yeah or there's concerns around it and I know there's there's obviously lots of other side effects that we won't go into but even um looking at articles that are written online even by researchers in this field it often feels like they're shaming the use of it and discouraging it and maybe for top level athletes where they're trying to fine tune the tiniest things there may be an alternative there but it's it's hard not to feel like there's judgment there yeah yeah and then moving on to so we talked about performance in the cycle

when it comes to PMS or premenstrual syndrome which affects a huge amount of people when it comes to exercise around this time I mean last night for example I said on Instagram that I went for a run it was day one of my period and the amount of messages I got from women being like I would not be able to leave my sofa on on the first day of my cycle or other women asking oh is it okay to exercise if I've got you know PMS or if I've got symptoms and things like that and I was just thinking I had this perfect timing for the podcast for us to like dive into this discussion so from a research point of view again we're talking about the same research field and it's not going to be the strongest evidence but what do we know about exercise and PMS and can it reduce symptoms or

does it worsen symptoms? Yeah so like you say in the general population it's reported that nearly up to 90% of women might suffer from PMS which ranges from physical and psychological symptoms in the days prior to your period. So in fact, there are something like 150 reported symptoms that we can experience from anxiety, swollen boobs, to bloating, headaches, tiredness, etc. And whilst there are different approaches and techniques for PMS, and all those different ones might work for different women, there is definitely a role for the likes of exercise for instance one study found that eight weeks of aerobic exercise was effective in reducing the symptoms of PMS likewise similar studies have shown that yoga is an

effective strategy for reducing PMS symptoms the mechanisms behind this effect however are unknown but two possible reasons is that exercise releases endorphins as well as the known anti-inflammatory effects of regular moderate exercise. But again, there is a need for that further research. In fact, there are something like five times more studies on erectile dysfunction, which 19% of men suffer from compared to PMS, is reported up to in 90% of women so a lot more can be done in this area but at the moment I think the key is finding what works for you and how you are feeling. Yeah I think I think that's the best takeaway and like you said the evidence points that you know it may actually help with symptoms and lots of various symptoms and whether that's mood or bloating or constipation and menstrual cramps but again some the degree to which some people get uh PMS I mean there's

there's a more severe form PMDD which is less common and some people just find their period or PMS extremely debilitating and just to kind of mention PMS usually starts before the period and then should disappear after one or two days into the period once it's started but yeah I mean I try to move around my my cycle but I definitely get that some some people feel really fatigued and that can be a barrier to exercise so it might just be gentle movement going for a walk or like you said there is some evidence that yoga may help yeah with symptoms yeah I was the same I couldn't have ever have exercised on my first day or the second day of my cycle and that was literally I just had to sort of rest and I found that was

better for me but now actually I am sort of a big advocate for moving on your period so I just had to sort of rest and I found that was better for me but now actually I am sort of a big advocate for moving on your period so I do like to get out there and move and I have found that it has made a massive difference in how I experience my cycle so yeah I think it's just trial and error of working out what works best for you. I think so and also I think there's like almost like this ingrained belief I definitely like feel like I had it at school, like amongst other girls that like if you had your period, you just like skipped PE. And like it's like this belief like you can't like partake in anything if you have your period. So I think I mean, once you feel OK, it's absolutely fine to go for it. It's so great that like more women are talking about it though

and are a bit more open about it. And I think what's been really fascinating this year, especially because more people are tracking their cycle and are a bit more tuned into it, is because we're obviously living in this crazy year of a coronavirus pandemic and everyone's world has been turned upside down. And what we're seeing is

a lot of women including female athletes are reporting like these changes to their menstrual cycle why why do we think this is yeah so there's been loads of changes to women's sport with the coronavirus pandemic but like you say one change is that increasing number of women reporting changes to their menstrual cycle so that's from painful periods worse PMS to late or even no periods at all and this has been the case in sports women so data from FitR Women shows that up to 45% of athletes have experienced some change in that menstrual cycle so at the moment in time like you say we're all living that slightly different life from the one that we would usually lead so So we've got different schedules, maybe it's different eating patterns, sleeping patterns, how we are exercising. Additionally, we all probably experience higher levels of stress,

and it's common to experience these types of changes in your cycle as a result. So stress can impact on the menstrual cycle as a result of changes in brain signals via the hpa axis so cortisol is one of the main stress hormones which tells our body that something might be going on that might require us to react which is a good thing when we need to get out of dangerous situations but the constant release of cortisol as well as other hormones like adrenaline can impact upon the production and release of other hormones. So namely those in charge of the menstrual cycle. And therefore you might experience changes in your cycle, such as late periods, no periods, as well as all of those additional symptoms.

So there's not going to be a real quick fix with this. And I guess the advice is just to look at areas where you might be able to reduce stress and restore a little bit of normality but that's obviously easier said than done so just being kind to yourself and recognizing it also um Anita the aka the gang geek was conducting an online study I'm sure about periods in COVID-19 but there's also a great chapter on stress in her book yeah absolutely we've had Anita on here before. And for, I mean, I'm sure everyone listening is well aware, but her book is also called The Gynae Geek,

which I think is available across the world if you just check it out on Amazon. But yeah, it's fascinating how the little changes in our environment or in our lives can absolutely shift our periods whether it's a big change like moving house or the COVID pandemic and that just kind of shows us how sensitive it is to changes whether it's you know any stress and stress doesn't have to be psychological stress so like work stress but it can be stress that you're not fueling your body you're not getting

enough nutrients in or stress that you're maybe exercising too much there's lots of ways that it can affect our periods and then I guess finally to finish what for you is the biggest myth on women's health that you would love to bust yeah so where there's a lack of knowledge, quite often, like you say, a myth can tend to fill that gap. So there are so many myths surrounding women's health. And some of them are really, really bonkers. But I guess the biggest one, particularly sort of from a sporting and exercising environment perspective, is the fact that menstrual cycles and periods are still bizarrely seen as that taboo topic and sometimes something that women need to be embarrassed about or hide away and not discuss

like at school we all used to shove tampons or pads up to our sleeves to go to the toilet so it was just something that you just never wanted to bring up so even in the sporting environment a recent survey showed that 81% of women have never discussed the impact of the menstrual cycle on performance and training with their coach. So actually, in sport, we're in that great position to just completely remove that taboo altogether. For example, in sport, we talk openly about everything to do with performance. So from nutrition, digestion, sleep. So why do we tend to leave periods out of that equation? The menstrual cycle is a natural biological process and should be considered in the same light as these other

natural physiological functions. And it's not just the menstrual cycle, there are other factors such as pelvic health, breast health, pregnancy, menopause, which all tend to go under the radar. So I think we need to speak out and encourage other women and exercising women and female athletes to speak out about these topics and not be afraid or embarrassed we need to make these topics the normal thing that they are and that means everyone should be part of the conversation so even men young girls boys none of us should be excluded and consequently the more we normalize the conversation the more education we have surrounding it the more we'll be able to further improve not

only women's performance but their health and well-being as well at the same time yeah absolutely that was a passionate speech no but it's so true i mean i think like I think it was the American College of Obstetrics and Gynecology released a statement a little while ago to say that it should be considered a vital sign like the menstrual cycle like just like we would take blood pressure temperature things like that when someone comes through the hospital I'm like yes like it's like none of my colleagues ever talk about apart from ops and gyne doctors will talk about periods but otherwise we just pretend that whole part

of a woman's physiology doesn't exist and it's it's mind-blowing yeah but thank you so much for coming on and chatting today it's been really fascinating that's great thank you for having me and I'm sure that we'll see more of you under period of the period and look forward to your own podcast coming out soon thank you thanks so much Kelly okay guys that's all from me thank you so much for tuning into today's episode don't forget to subscribe and leave us a review and hopefully a five-star rating if you love what you hear on this podcast and don't forget that you can hear more from me over on social media under at the food medic and my website thefoodmedic.co.uk please do send us a tweet instagram message or facebook message if you have some suggestions on who or what you'd like to hear from on the next podcast

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